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SAN JOAQUIN COUNTY <br /> NOTIFICATION OF HAZARDOUS WASTE DISCHARGE <br /> HEALTH & SAFETY CODE 25180.1 <br /> A. EMERGENCY LEVEL: II III PHS-EH LOG # 'ZI <br /> —77 <br /> (Circle One) <br /> B. SOURCE OF INFORMATION <br /> a btemGssr t" F <br /> Original Source: cDari 5avx [o 1181 Telephone: { � <br /> Reporting Agency Name: �-- <br /> I <br /> Agency Contact: 0g bDeA Telephone: (g, <br /> _J� ) (g, �O O <br /> Address: t_-2� t35 ' w���o . q. Sv L k toi, Com6rd 64 ITC1JZ C0 <br /> C. LOCATION AND DATE OF DISCHARGE + <br /> Location: qro ':3 G rah 1G <br /> (Best Physical Description)' (City or County) <br /> Date of Discharge: U n On -- <br /> , pa <br /> Date Notified: Time: <br /> D. RESPONSIBLE PERSON/BUSIN S <br /> Name of Business CJOt) �Ck-vx <br />` L163 - 2-711 <br /> Contact Person: Vjlt-- Telephone: is <br /> Physical Address: Rg v-ccict m411Q'zC IJL `310 <br /> E. DESCRIPTION <br /> �easQ11 �� 4{5�� <br /> Type Release: <br /> Volume: <br /> Chemicals: <br /> F: ACTION TAKEN <br /> Q!3jm rovIrld <br /> EH 22 013(Rev. 02/90) <br /> r <br /> H <br /> i <br />